FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/KA/ROAD/45454/2020   (ii). Name of Project for which Forest Land is required : Improvements of Existing road to Malemalleshwara Swamy Temple Coming in 0.94 Hectares of forest Land out of 17.03 Hectares of forest land already leased to Suzlon energy limited, in Seegegudda kaval in Hassan Taluk and Hassan District   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : The Proposed road comes in Hassan District, Hassan Taluk. This is the main connectivity road for the historical Male-malleshwara Swamy Temple exists in the top of the Seegegudda, a local hillock coming in the Seegegudda Kaval forest area. The Proposed road is a kachcha mud road runs from foot of t   (iv). State : Karnataka   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 300   (viii). Area of forest land proposed for diversion(in ha.): 0.94   (ix). Non-forest land required for this project(in ha.): 0   (x). Total period for which the forest land is proposed to be diverted(in years): 20
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINEER HASSAN   (ii). Address1 : Public Works, Ports and Inland water Transport Department, Hassan Division, Hassan   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Hassan   (vi). Pin : 573201   (vii). Landmark : PWD Office Complex   (viii). Email address : executiveengineerhsn@gmail.com   (ix). Landline Telephone No. : 8172-268437   (x). Fax No. : 8172-   (xi). Mobile No. : 7899393161   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Ramesh   (ii). Middle Name: NIL   (iii). Last Name: H   (iv). Gender: Male   (v). Designation: Assistant Executive Engineer   (vi). Address 1: Public Works, Ports and inland water transport Department, Special Sub Division , Hassan   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Hassan   (x). Tehsil: Hassan   (xi). Pin: 573201   (xii). Landmark: PWD OFFICE COMPLEX   (xiii). Email Address: channegowdapwd@gmail.com   (xiv). Landline Telephone No.: 8172-233335   (xv). Fax No.: NIL   (xvi). Mobile No.: 9448811282   (xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B. Details of land required for the Project
B-1. Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
NIL
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved
S.no Division Name Forest Land(ha.) Non-Forest Land(ha.)
1.Hassan0.940
Total0.940
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Hassan0.940
Total0.940
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Seegegudda Kaval Sy No 740.940
Total 0.94 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Carriage way0.7590
2Shoulders0.121440
3Side Drain0.0592020
Total 0.939642 0
C. Maps of forest land proposed to be diverted
Division 1. : Hassan
  (i). Area of forest land proposed to be diverted(in ha.) : 0.94   (ii). Nature of the Project: Linear   (b). No. of Segments : One
Segment wise details
Segments Segment Area(in ha.) Kml File of Segments
(To view KML file on google the same may be downloaded and then open if in google earth install in your computer).
1.0.94    View File
  (iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:   (iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D. Justification for locating the Project in forest land and details of alternatives examined:
  (i). Copy of note containing justification for locating the Project in forest land:   (ii). Whether a copy of map indicating location of alternative examine is required to be provided: No   (a). Reason for not providing such map: Because its improvement of road proposal
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: No
F. Displacement of People due to the Project, if any
  (i). Whether Project involves displacement?: No
G. Details of Cost-Benefit analysis for the Project
  (i). Whether the Project requires Cost-Benefit analysis?: No
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : No
I. Status of Wildelife Clearance
  (i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? : No
J. Applicability of special provisions governing Scheduled Areas
  (i).Whether the Project or a part thereof is located in a Scheduled Area? : No
K. Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
  (i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? : No
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Not Applicable   (ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Not Applicable
Additional information Details
Documents
S.No Documents
Remarks
1NOC issued from competent authorities of Suzlon Energy Limited Vide Lr.No:SEL/Seegegudda-17.03 Ha/2020-21 Dtd:20/11/2020 to accord permission for Improvements of Existing road to Malemalleshwara Swamy Temple Coming in 0.94 Hectares of forest Land out of 17.03 Hectares of forest land already leased to Suzlon energy limited, in Seegegudda kaval in Hassan Taluk and Hassan District vide lease deed, agreement no: 3/2006-07 Dtd:28/04/2015.
2Justification for considering the total land required in non-forest land is ‘Zero’ in ref item FORM-A Sl.No.A-1 (ix) of the Proposal.
3B.2.3 Vilagewise Breakup
4Administrative Approval letter in Kannada and English translated letter
5Detailed Project report
6Cross Sections
7Undertaking for NPV and Compensatory afforestation
8Undertaking regarding land marking of road in Forest land for inspection
9GPS Readings for the proposed road in forestland.
10Topo Sheet
11Geo Referenced Maps
12L-Section of Proposed Improvements of Existing road to Malemalleshwara Swamy Temple Coming in 0.94 Hectares of forest Land out of 17.03 Hectares of forest land already leased to Suzlon energy limited, in Seegegudda kaval in Hassan Taluk and Hassan District.